Finland's policy makers are taking a bold step against the threat of an avian flu pandemic.
In response to a recommendation by the World Health Organization, according to which the avian influenza pandemic threat is real, Finland is preparing to vaccinate its entire population against the disease.
The argument against doing this is that if H5N1 bird flu makes the mutational jump into easy transmissibility in human populations then that strain may be (probably would be) immunologically different than whatever H5N1 strain(s) Finland chooses to immunize against.
So then is the Finnish government wasting time and money? I can think of two arguments for why a preliminary vaccine might help. I'd really like to know if either or both arguments have any scientific merit: A) Partial immunity from a premature vaccine would reduce the lethality of an eventual pandemic infection and/or B) Vaccination by a premature H5N1 vaccine would reduce the size or number of a later vaccine dose using a more exact antigen target made to match an eventual pandemic strain (assuming such a strain will arise).
One reason put forward for why avian H5N1 influenza vaccine doses must be very large (see below) is that humans have few antibodies aimed at anything remotely like H5N1 since it is a bird influenza. Well, couldn't we treat the current strains of H5N1 as basically trainer strains to teach the human immune system about that category of influenza? Is there some reason to expect a future pandemic strain of H5N1 to be much more antigenically different from current H5N1 than human influenza strains are different from each other over a period of a few years?
If either of these arguments has merit then affluent folks who see avian flu as a big threat might want to start planning a medical tourism trip to Finland or to any other country that announces plans to vaccinate their entire population.
Recent vaccine testing for H5N1 bird flu found that 12 times the normal vaccine dose was needed for a good immune response against H5N1. That's very bad news. Assuming such a large dose size then current existing worldwide vaccine production capacity could make only 25 million doses per year against H5N1 influenza. By contrast when used against conventional human influenza strains world production capacity translates to 300 million yearly doses. The French vaccine maker Sanofi Pasteur is rumoured to be conducting trials using just 3.5 micrograms (as compared to the standard 15 microgram dose or 2 90 mch doses for H5N1) of H5N1 antigen plus an adjuvant compound to enhance immune response. If Sanofi Pasteur's trial works and all vaccine makers can follow the same approach then worldwide yearly production would effectively quadruple to 1.2 billion doses per year.
Current H5N1 test vaccines have to be taken as two large doses several weeks apart (and, yes, you would therefore be at risk of infection for those several weeks). The ability to produce much smaller single dose vaccines would greatly reduce the length of a pandemic, the death toll, and the size of the economic disruption. Therefore a lot potentially rides on a successful outcome of Sanofi Pasteur's trials.
70% of the world's flu vaccines are produced in Europe.
Most of the world's flu vaccine is produced in nine countries: Australia, Britain, Canada, France, Germany, Italy, Japan, the Netherlands and the United States. Europe produces 70% of the vaccines. And Europe's vaccine producers are worried.
Each nation on that list is a potential place to get a preliminary bird influenza vaccine before a pandemic hits. How about a medical tourism tour of European bird flu vaccine producing countries? Get about 3 or 4 different preliminary H5N1 vaccines and hope for a decent amount of partial immunity.
Canada's "pandemic readiness" fee contract for vaccine production sounds like the best idea I've heard for flu pandemics so far.
Canada, for example, recently signed a ten-year agreement with a manufacturer for its seasonal vaccine supply, and the country also pays an annual “pandemic readiness fee” which stipulates the company has the capacity to produce 8m doses of vaccine per month for four months.
Canada would still face an up-front delay of some months (3, 4, 5, 6 perhaps?) for developing the vaccine to put into production. But if their supplier can live up to that contract then any pandemic would last for less than a year in Canada. But my guess is that contract is based on the assumption that normal vaccine dose sizes would be used. So Canada's preparedness probably still depends on an optimistic expectation about dose size.
By Randall Parker at 2005 October 02 09:24 PM Pandemic Vaccines | TrackBackNotice that the countries that can afford to take precautions are the rich Westernised successful economies?
The use of adjuvants concerns me; I've read that some of them have a history of inducing autoimmune responses. If we save 7% of the population from a rapid death at the cost of disabling 10% in the long term, I'm not sure we're ahead.
It is natural to wonder if the Finnish government has attempted to estimate the number of people that might die from the vaccine or suffer other negative health consequences from a massive immunization campaign. (Engineer-Poet wonders about possible autoimmune responses.) Here is an excerpt from another article about avian flu vaccines at the same Finnish news website:
Finland is stocking up on the model vaccine, because it is believed to give some protection against a mutated virus. Kilpi says that Finland hopes to make purchase agreements for the vaccines this year. The problem is that the present bird flu vaccines have not been thoroughly clinically tested.So the possible side-effects appear to be unknown. The article makes a distinction between a "model vaccine" that is available now and a hoped for "precision vaccine" that may be available at a later date. Apparently, they plan to use a "model vaccine" and then follow up with a "precision vaccine."Trials involving tens of thousands of people will not be possible before the outbreak of the pandemic, and the use of the vaccine would be exceptionally extensive. For that reason, the pharmaceutical industry wants to limit its liability for possible side effects.
The vaccine makers would like to be limit their liability from side effects. The US government will probably have to guarantee any damages awarded in court to get these companies to ramp up for the US market. Will this be a good deal for amercan taxpayers?
This to me appears a bit hasty. This would not be the first time that scientists-turned-bureaucrats at the NIH or WHO had over-hyped a problem in order to bolster budgetary demands. There is a danger from moving too quickly.
Sensei,
It appears you are prescient as in the 48 hours since your post the issue of avian
flu and what is to be done about it has now entered into the political 'arena'. Bush
speaks of using the military to enforce a quarantine ( good idea) while the Democrats
are out and about accusing the administration of not doing enough.
Problem is, if the issue gets politicized there's a good chance nothing will be done.
Can't these G*dammned politicians ever do something for the country instead of just
for their own careers.
Clearly they need to get cracking on some preparations but whatever the Republicans do
the Democrats will say they should have done something else.
Personally I like the idea of trying to stamp any infection out at the get go. With HIV
AIDS no effort was made in San Francisco and some other epicenters to try and stop the
spread because it became a political football. Gay bath houses and other known venues for
the spread of AIDS were left open because the homosexual community did not want to be
stigmatized. Instead we got an utterly useless "AIDS awareness" program and an ever
growing quilt!
The Canadians OTOH did a pretty good job with SARS as did Hong Kong when they first
encountered avian flu in their territory almost a decade ago. Contact tracing is going
to be a must IMO should avian flu appear in this country. Traditional public health
measures of the kind that they utilized in the 19th century are going to be as much a
part of limiting the spread of avian flu as vaccines and tamiflu.
It does seem that the nations are preparing for the worst. However, what is their urgency level? Is it only lip service or is it at a fevered-pitch. Additonally, I've read that it will take years to get the US up to 20% coverage for the vaccine...we're as prepared (if not worse) than 3rd world country.
Hello. Sorry if this is a foolish question (no one seems to be asking it).
What can I do right now to protect my family right now, today?
Can I buy the vaccine somewhere and take it?
Should I purchase Tamiflu (antivirul) and take it?
What about Relenza?
Any advice you could give would be greatly appreciated.
Thank you.
To develop a H5N1 vaccine is one thing, another is how to produce sufficient doses. To my knowledge practically all influenza vaccine producers base their production on eggs. In a pandemic situation you would definitely face a situation where there a) are no eggs available and b) if there were there would be ban on transportation; and c) with two eggs for one vaccine imagine the enormous numbers of eggs that is needed.
Of course cell culture is the solution, but how many are able to do that, and if so - how many have the skills to increase from small scale production to 2 - 3,000 liter reactors...?
And the way governments is fidling about this, talking and thinking - the flu seson approaches. I really don't see how we can cope if the pandemic arrives the next 3 - 6 months...other than pray!
To develop a H5N1 vaccine is one thing, another is how to produce sufficient doses. To my knowledge practically all influenza vaccine producers base their production on eggs. In a pandemic situation you would definitely face a situation where there a) are no eggs available and b) if there were there would be ban on transportation; and c) with two eggs for one vaccine imagine the enormous numbers of eggs that is needed.
Of course cell culture is the solution, but how many are able to do that, and if so - how many have the skills to increase from small scale production to 2 - 3,000 liter reactors...?
And the way governments is fidling about this, talking and thinking - the flu seson approaches. I really don't see how we can cope if the pandemic arrives the next 3 - 6 months...other than pray!
To develop a H5N1 vaccine is one thing, another is how to produce sufficient doses. To my knowledge practically all influenza vaccine producers base their production on eggs. In a pandemic situation you would definitely face a situation where there a) are no eggs available and b) if there were there would be ban on transportation; and c) with two eggs for one vaccine imagine the enormous numbers of eggs that is needed.
Of course cell culture is the solution, but how many are able to do that, and if so - how many have the skills to increase from small scale production to 2 - 3,000 liter reactors...?
And the way governments is fidling about this, talking and thinking - the flu seson approaches. I really don't see how we can cope if the pandemic arrives the next 3 - 6 months...other than pray!
avian flu has killed 46 people and infected 69 since 2003
if these are correct figures in a country where people live
in less sanitary and more crowded conditions, I am afraid
major backers of the pandemic concept (Mr Bush ie. or Canadas
Govt officials who are connected to pharmaceutical companies)
, may be wagging the dog. In the US the people are being flooded
with concepts like go back to the moon, beware of nukes in nonChristian anti- US hands, Terrorist plots the puppies there
must have very sore backsides. The Swine Flu hass finally arrived
from a ranch in Texas.
terrorist attacks??
the dog